颅颈畸形患者寰齿间隙及脑干脊髓角测定

Measurement of atlanto-odontoid distance and brainstem spinal cord angle of congenital craniocervical malformation patients

目的:通过测量寰齿间隙、脑干脊髓角探讨颅颈连接畸形的不稳定性因素。方法:选择颅颈连接畸形患者40例(畸形稳定组8例、畸形不稳定组32例)和正常对照20例,测量寰齿间隙、脑干脊髓角,并对各种畸形(寰枕融合、颅底凹陷、C2-3分节不全)发生率进行统计。结果:畸形组寰齿间隙测量值大于对照组,脑干脊髓角测量值小于对照组,差异均有统计学意义(P均<0.05)。畸形组不稳定组的寰枕融合、颅底凹陷发生率高于畸形稳定组,差异有统计学意义(P均<0.05),稳定与不稳定组间C2-3分节不全发生率差异无统计学意义(P>0.05)。结论:寰枢间隙愈大、脑干脊髓角愈小颅颈连接不稳定发生的可能性愈大。寰枕融合、颅底凹陷是导致先天性颅颈连接畸形不稳定的主要原因,且不稳定发生率较高。

Aim： To explore the instable factors of the patients with congenital craniocervical malformation through the measurement of the atlanto-odontoid distance and brainstem spinal cord angle.Methods：A total of 40 cases of congenital craniocervical malformation patients（8 cases of stable and 32 cases of instable） and 20 normal subjects were collected.The atlanto-odontoid distance and brainstem spinal cord angle were detected.And the incidence of atlanto-occipital fusion,basilar invagination,and segmentation failure of C2-3 was detected.Results： Compared with control group,atlanto-odontoid distance increased,brainstem spinal cord angle decreased in congenital craniocervical malformation group（P〈0.05）.There were significant differences of the incidences of atlanto-occipital fusion,basilar invagination between two congenital craniocervical malformation groups（P〈0.05）,except incidence of segmentation failure of C2-3（P〉0.05）.Conclusion： The larger distance between atlas and odontoid process and the smaller brainstem spinal cord angle among the patients,the more probable the instability of craniovertebral junction.The basilar invagination and atlanto-occipital fusion are one of the instable factors of craniovertebral junction.The incidence of instabilities among the patients with complex congenital abnormalities is high.